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https://josr - online.biomedcentral.com/articles/10.1186/1749 - 799X - 7 - 11
Extracorporeal shockwave therapy in
musculoskeletal disorders
Ching - Jen Wang Email author
Journ of Orthopaedic Surgery and Research 2012 7 :11 / https://doi.org/10.1186/1749 - 799X - 7 - 11
© Wang; licensee BioMed Central Ltd. 2012
Extracorporeal shockwave therapy (ESWT) began with an incidental observation of
osteoblastic response pattern during animal studies in the mid
- 1980 that generated an
interest in the application of ESWT to musculoskeletal disorders. In the past 10 to 15
years, shockwave therapy had emerged as the leading choice in the treatment of many
orthopedic disorders including proximal plantar fasciitis of the heel [
1 , 2 , 3 , 4 , 5 , 6 ],
lateral epicondylitis of the elbow [ 7 , 8 , 9 , 10 ], calcific tendinitis of the shoulder [ 11 , 12 ]
and. non - union of long bone fracture [ 13 , 14 , 15 ]. More recently, the use of ESWT had
expanded to the treatment of patellar tendinopathy (jumper's knee) and Achilles
tendinopathy [
16 , 17 , 18 , 19 ], and avascular necrosis of the femoral head [ 20 , 21 , 22 ].
ESWT has gained significant acceptance from Europe (Germany, Austria, Italy and
others) to South America (Brazil, Columbia, Argentina and others), Asia (Korea,
Malaysia, Taiwan and others) and North America (Canada and USA), and this had led to
the change of European Society for Musculoskeletal Shockwave Therapy to International
Society for Musculoskeletal Shockwave Therapy (ISMST) in 2
000. In USA, FDA (Food
and Drug Administration) first approved the specific shockwave device, OssaTron (High
Medical Technology, Lengwil, Switzerland, now Sanuwave/Alpharetta, GA) for the
treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis of the elbow in
2003. FDA also approved Epos (Dornier Medical System, Kennesaw, GA) for the
treatment of plantar fasciitis and Sonocur (Siemens Medical Systems, Iselin, NJ) for the
treatment of lateral epicondylitis of the elbow in 2002, Orthospec (Medispec,
Germantown, MD) and Orbasone (Orthometrix, White Plains, NY) for the treatment of
plantar fasciitis in 2005.
In the meantime, many off - label uses of ESWT were also studied
including calcific tendinitis of the shoulder, patellar tendinopathy, Achilles tendinopathy,
and non
- union of long bone fracture, avascular necrosis of the femoral head and others.
The vast majority of the published papers including randomized control trials and cohort
studies showed positive effects and evidence base medicine in favor of ESWT [
1 , 2 , 3 , 4 ,
5 , 6 , 8 , 9 , 10 , 11 , 12 , 23 ]. However, a few studies reported that ESWT is ineffective or
less effective with the results comparable to the placebo effect [ 7 , 24 , 25 ], and this has
stirred up the debate and controversy. This article reviews the current status of ESWT in
the treatment of musculoskeletal disorders.
Medical Literature